Description
Working With a Suicidal Client
Individuals diagnosed with depressive disorders and bipolar and related disorders are at risk for attempting and committing suicide. Therefore, it is important to accurately assess a client’s risk for suicidal and/or homicidal tendencies. To maintain a high level of care and plan appropriate treatment, you should always consider the risk of suicide/homicide in clients with depressive disorders and bipolar and related disorders. This is true even when a client does not routinely entertain thoughts of suicide/homicide or when such issues are not the specific focus of the counseling session.
To prepare:
- Review this week’s Learning Resources.
- Focus on one of 3 cases (“A Successful Total Failure”, “Jennifer” or “Sped Up and Out of Control” ) in Chapter 7 of the text.
- Consider the client’s potential risk for suicide/homicide.
With these thoughts in mind:
Post by Day 4 a brief summary of one of 3 cases mentioned above. Construct and explain your diagnosis. Identify which disorders you would want to rule out. Explain what potential risks for suicide/homicide may be present with this client and how you would make this determination. Explain your recommendations for treatment, ongoing assessment, and follow-up with the client. Explain any challenges that might occur and how you might address them.
Be sure to support your postings and responses with specific references to the Learning Resources.
person
must be in a major depressive episode and never have
had a manic, hypomanic, or mixed episode.
The following account illustrates a moderately severe
case of MDD.
Jennifer
Jennifer is a 35-year-old graphic designer who is married and has
three young children at home. She has been running a successful,
and growing, business out of her home
ice, which she has really
enjoyed because working from home allows her the time and flexibil-
ity to be with her children when they are not in school. Jennifer expe-
rienced a major life stressor 6 months ago when her husband of
15 years, Michael, told her that he is leaving her for a younger
woman he met at his job. Jennifer was totally blindsided by this
news. After an initial period of trying to work things out, Michael
moved out of the house. Jennifer continued on with her business
and managing of her household for several weeks, but then things
started to change. She felt increasingly sad and would have long
periods of crying throughout the day several times per week.
Whereas she used to enjoy work, time with her children, and going
out with her girlfriends, none of that seemed fun anymore. Even
“movie nights” at home with the kids, which was one of her favorite
times of the week, just wasn’t enjoyable to her anymore. Her body
felt heavier and heavier and she lacked the energy to keep up
appointments, leading her business to decline-she began losing
even her most loyal clients. Jennifer also had difficulties managing
her household, on several occasions forgetting to pick up her chil-
dren from school and not remembering to make dinner for the family.
Her eating and sleeping both declined drastically, and she spent
hours lying in bed feeling like she had let down her husband, her
children, and her friends. In addition to her extreme sadness, Jennifer
began to experience extreme anxiety and worry in multiple domains.
How would her business succeed? If she lost her business, wouldn’t
she lose her house? Would she lose her children as well? Who
would take care of them? She wanted to address all of these things
but felt paralyzed and unable to take action. This led her to feel even
more like a failure. She believed she was completely worthless and
began contemplating whether everyone wouldn’t be better off if she
was dead, which increased to explicit and frequent thoughts of suicide.
and anxiety disord
2005). The issues su
sion and anxiety, w]
tion in recent years,
DEPRESSION ASF
diagnosis of MDD
whether this is a firs
or a recurrent episod
episodes). Depressi
9 months if untreate
people with MDD,
2 years, in which ca
diagnosed (Boland
Chronic major depres
childhood family pro
childhood (Angst et a
Although most a
not said to occur unt.
for at least 2 months)
some future point. TI
two types: relapse ar
return of symptoms
situation that probab
ing episode of depr-
(Boland & Keller, 200
relapse may common
terminated premature
but before the underl
& Dimidjian, 2009).
Recurrence, which
of depression, occurs in
people who experience
Harkness, 2011). The
with the number of pric
son has comorbid diso
experience multiple de
symptom-free in betwee
depressive symptoms h-
et al., 1998). Moreover,
toms, or with significant
Jennifer’s case illustrates that a person with MDD
shows not only mood symptoms of sadness but also a yari-
(Goodwin
ang, 1996).
The following case illustrates both phases of bipolar I
cient
episo
are le
disorder
ns
a
far n
Sped Up and Out of Control
Tim is a 25-year-old student and aspiring poet, rapper, and musi-
cian. He was just admitted to a psychiatric hospital in an apparent
manic episode. Although he has had a fairly stable life in which he
6o
ntil
100
Elin
and
een.
erm
the
recogs
Ві
(altho
wome
young
years
Bipola
mately
et al., 2
disorde
extreme
of cases
or imm
cases, ti
by inter
illustrat
and dep
in bipola
disorder
they are
on only
Moreove
ence sigr
personal
many as
lives with his girlfriend, Tessa, takes classes at the local community
college, and works at a coffee shop in town, his behavior has
become increasingly erratic. More specifically, his girlfriend reports
that Tim has appeared to be “really sped up” the past month, talking
faster than usual, expressing some pretty grandiose ideas (e.g., “I’m
going to start and finish a PhD in poetry this year,” “I set up a meeting
with Kanye West to discuss signing with him,” and “I am Tupac rein-
carnated!”). Tessa reports that things have gotten much worse dur-
ing the past 2 weeks, during which Tim sleeps just 1 to 2 hours per
night and spends the rest of his time in the evenings making music,
smoking marijuana, and buying expensive items online (he has
maxed out their credit cards buying multiple guitars, turntables, a
new refrigerator, and a five-star trip to Paris). She also reports that
Tim disappeared for the past 4 days (skipping school and work as
well), only to return home this morning saying that he “has been liv-
ing with another woman he just met.” Tessa says that this is all very
out of character for Tim. Since she has known him he has had peri-
ods of pretty severe depression during which he becomes extremely
sad, stops playing or making music, sleeps most of the day, and
xed
own
eek,
ays.
but
120
cast
–
ety
barely leaves the house. However, she has never seen him so sped
up and out of control and he has become a completely different
person these past few weeks.
sonal pro
depressio
which cas
DSM-5 also identifies a distinct form of bipolar dis-
order called bipolar II disorder, in which the person
diagnosec
A Successful “Total Failure”
Sophie, a junior in coliege, was getting all A’s in her classes, working
in her spare time as a research assistant in a psychology laboratory,
and had a lot of great friends and a 2-year relationship with the guy
of her dreams. Things soon changed, however, when her boyfriend
unexpectedly told her that he was leaving her for someone else. Fol-
lowing her initial shock and rage, she began to have uncontrollable
crying spells and doubts about her other relationships and even
about her abilities in the classroom and research lab. Decision mak-
ing became an ordeal. Her spirits rapidly sank, and she began to
spend more and more time in bed, refusing to talk with anyone. Her
alcohol consumption increased to the point where she was seldom
entirely sober. Within a period of weeks, her grades plummeted due
to her inability, or refusal, to attend class or complete any assign-
ments. She felt she was a “total failure,” even when her friends
reminded her of her considerable achievements; indeed, her self-
criticism gradually spread to all aspects of her life and her personal
history. Finally, her parents intervened and forced her to accept an
appointment with a clinical psychologist.
Was something “wrong” with Sophie, or was she merely expe-
riencing normal human emotions because of her boyfriend having
deserted her? The psychologist concluded that she was suffering
from a serious mood disorder and initiated treatment. The diagnosis,
based on the severity of the symptoms and the degree of impair-
ment, was major depressive disorder. Secondarily, she had also
developed a serious drinking problem-a condition that frequently
co-occurs with major depressive disorder.
by intense a
euphoria. Sor
only time per
moods. Howe
at certain tim
time points. N
types of episc
often conceive
uum, with no
cept is accurat
have sympton
time period. L.
ences rapidly
ria, and irritat
Types of
We will first
which a perso
then move on
person experie
The most
a depressive
depressed or
ties (or both)
toms such as
worthlessness
The other
episode, in w
euphoric, or e
sional outburs
particularly
manic person
Most of us feel depressed from time to time. Failing an
exam, arguing with a friend, not being accepted into one’s
first choice of college or job, and breaking up with a roman-
tic partner are all examples of events that can cause a
depressed mood in many people. However, mood disor-
ders involve much
mood for
Purchase answer to see full
attachment
must be in a major depressive episode and never have
had a manic, hypomanic, or mixed episode.
The following account illustrates a moderately severe
case of MDD.
Jennifer
Jennifer is a 35-year-old graphic designer who is married and has
three young children at home. She has been running a successful,
and growing, business out of her home
ice, which she has really
enjoyed because working from home allows her the time and flexibil-
ity to be with her children when they are not in school. Jennifer expe-
rienced a major life stressor 6 months ago when her husband of
15 years, Michael, told her that he is leaving her for a younger
woman he met at his job. Jennifer was totally blindsided by this
news. After an initial period of trying to work things out, Michael
moved out of the house. Jennifer continued on with her business
and managing of her household for several weeks, but then things
started to change. She felt increasingly sad and would have long
periods of crying throughout the day several times per week.
Whereas she used to enjoy work, time with her children, and going
out with her girlfriends, none of that seemed fun anymore. Even
“movie nights” at home with the kids, which was one of her favorite
times of the week, just wasn’t enjoyable to her anymore. Her body
felt heavier and heavier and she lacked the energy to keep up
appointments, leading her business to decline-she began losing
even her most loyal clients. Jennifer also had difficulties managing
her household, on several occasions forgetting to pick up her chil-
dren from school and not remembering to make dinner for the family.
Her eating and sleeping both declined drastically, and she spent
hours lying in bed feeling like she had let down her husband, her
children, and her friends. In addition to her extreme sadness, Jennifer
began to experience extreme anxiety and worry in multiple domains.
How would her business succeed? If she lost her business, wouldn’t
she lose her house? Would she lose her children as well? Who
would take care of them? She wanted to address all of these things
but felt paralyzed and unable to take action. This led her to feel even
more like a failure. She believed she was completely worthless and
began contemplating whether everyone wouldn’t be better off if she
was dead, which increased to explicit and frequent thoughts of suicide.
and anxiety disord
2005). The issues su
sion and anxiety, w]
tion in recent years,
DEPRESSION ASF
diagnosis of MDD
whether this is a firs
or a recurrent episod
episodes). Depressi
9 months if untreate
people with MDD,
2 years, in which ca
diagnosed (Boland
Chronic major depres
childhood family pro
childhood (Angst et a
Although most a
not said to occur unt.
for at least 2 months)
some future point. TI
two types: relapse ar
return of symptoms
situation that probab
ing episode of depr-
(Boland & Keller, 200
relapse may common
terminated premature
but before the underl
& Dimidjian, 2009).
Recurrence, which
of depression, occurs in
people who experience
Harkness, 2011). The
with the number of pric
son has comorbid diso
experience multiple de
symptom-free in betwee
depressive symptoms h-
et al., 1998). Moreover,
toms, or with significant
Jennifer’s case illustrates that a person with MDD
shows not only mood symptoms of sadness but also a yari-
(Goodwin
ang, 1996).
The following case illustrates both phases of bipolar I
cient
episo
are le
disorder
ns
a
far n
Sped Up and Out of Control
Tim is a 25-year-old student and aspiring poet, rapper, and musi-
cian. He was just admitted to a psychiatric hospital in an apparent
manic episode. Although he has had a fairly stable life in which he
6o
ntil
100
Elin
and
een.
erm
the
recogs
Ві
(altho
wome
young
years
Bipola
mately
et al., 2
disorde
extreme
of cases
or imm
cases, ti
by inter
illustrat
and dep
in bipola
disorder
they are
on only
Moreove
ence sigr
personal
many as
lives with his girlfriend, Tessa, takes classes at the local community
college, and works at a coffee shop in town, his behavior has
become increasingly erratic. More specifically, his girlfriend reports
that Tim has appeared to be “really sped up” the past month, talking
faster than usual, expressing some pretty grandiose ideas (e.g., “I’m
going to start and finish a PhD in poetry this year,” “I set up a meeting
with Kanye West to discuss signing with him,” and “I am Tupac rein-
carnated!”). Tessa reports that things have gotten much worse dur-
ing the past 2 weeks, during which Tim sleeps just 1 to 2 hours per
night and spends the rest of his time in the evenings making music,
smoking marijuana, and buying expensive items online (he has
maxed out their credit cards buying multiple guitars, turntables, a
new refrigerator, and a five-star trip to Paris). She also reports that
Tim disappeared for the past 4 days (skipping school and work as
well), only to return home this morning saying that he “has been liv-
ing with another woman he just met.” Tessa says that this is all very
out of character for Tim. Since she has known him he has had peri-
ods of pretty severe depression during which he becomes extremely
sad, stops playing or making music, sleeps most of the day, and
xed
own
eek,
ays.
but
120
cast
–
ety
barely leaves the house. However, she has never seen him so sped
up and out of control and he has become a completely different
person these past few weeks.
sonal pro
depressio
which cas
DSM-5 also identifies a distinct form of bipolar dis-
order called bipolar II disorder, in which the person
diagnosec
A Successful “Total Failure”
Sophie, a junior in coliege, was getting all A’s in her classes, working
in her spare time as a research assistant in a psychology laboratory,
and had a lot of great friends and a 2-year relationship with the guy
of her dreams. Things soon changed, however, when her boyfriend
unexpectedly told her that he was leaving her for someone else. Fol-
lowing her initial shock and rage, she began to have uncontrollable
crying spells and doubts about her other relationships and even
about her abilities in the classroom and research lab. Decision mak-
ing became an ordeal. Her spirits rapidly sank, and she began to
spend more and more time in bed, refusing to talk with anyone. Her
alcohol consumption increased to the point where she was seldom
entirely sober. Within a period of weeks, her grades plummeted due
to her inability, or refusal, to attend class or complete any assign-
ments. She felt she was a “total failure,” even when her friends
reminded her of her considerable achievements; indeed, her self-
criticism gradually spread to all aspects of her life and her personal
history. Finally, her parents intervened and forced her to accept an
appointment with a clinical psychologist.
Was something “wrong” with Sophie, or was she merely expe-
riencing normal human emotions because of her boyfriend having
deserted her? The psychologist concluded that she was suffering
from a serious mood disorder and initiated treatment. The diagnosis,
based on the severity of the symptoms and the degree of impair-
ment, was major depressive disorder. Secondarily, she had also
developed a serious drinking problem-a condition that frequently
co-occurs with major depressive disorder.
by intense a
euphoria. Sor
only time per
moods. Howe
at certain tim
time points. N
types of episc
often conceive
uum, with no
cept is accurat
have sympton
time period. L.
ences rapidly
ria, and irritat
Types of
We will first
which a perso
then move on
person experie
The most
a depressive
depressed or
ties (or both)
toms such as
worthlessness
The other
episode, in w
euphoric, or e
sional outburs
particularly
manic person
Most of us feel depressed from time to time. Failing an
exam, arguing with a friend, not being accepted into one’s
first choice of college or job, and breaking up with a roman-
tic partner are all examples of events that can cause a
depressed mood in many people. However, mood disor-
ders involve much
mood for
Purchase answer to see full
attachment
